Access System For Endoscopic Operations

ABSTRACT

An access system for endoscopic operations includes of a trocar, a cover that is fittable on the trocar and at least one spreading element having a retaining portion and an effector portion, wherein the access system has, between the trocar and the cover in the fitted state, a receiving region for the retaining portion of the at least one spreading element. Furthermore, the access system can include an extraction bag which is expanded by the effector portion of the at least one spreading element

TECHNICAL FIELD

The present invention relates to an access system for endoscopic operations, having the possibility of expanding an extraction bag located in a body cavity in order for example to cut up the contents thereof by means of a morcellator and remove them from the body cavity.

BACKGROUND

Endoscopic operations for removing diseased tissue are known. To this end, an endoscope and one or more access means, for example trocars, are introduced into the body cavity in question and the affected tissue detached, for example by means of high-frequency surgery. If the pieces of tissue are small pieces of tissue, they can be removed from the body cavity through one of the access means. However, if the detached pieces of tissue are too large for removal through an access means, they have to be cut up prior to removal. This can be carried out for example by means of what is known as a morcellator, which has a rotating blade and a working duct passing through it. In this way, smaller pieces can be cut off large pieces of tissue and removed from the body cavity. In the case of infectious tissue, however, there is the risk of the disease spreading during the cutting up of the pieces of tissue, simply because tiny remnants of diseased tissue could remain in the body.

In order to prevent the spread of a disease, it is sensible to place a detached infectious piece of tissue in an extraction bag, also known as an endobag, to guide the open end of the latter through the access duct, and to morcellate the diseased piece of tissue in the extraction bag. This ensures that no remnants of infectious tissue remain in the body cavity. However, during endoscopic operations, body cavities are generally insufflated, i.e. a gas (nitrogen, carbon dioxide, helium etc.) is blown in in order to expand the body cavity. As a result, the surgeon is provided with more operating space.

However, as a result of the positive pressure within the body cavity, the extraction bag containing the detached diseased tissue is compressed so much that it is difficult if not impossible to detach the small pieces of tissue with the morcellator and remove them. In addition, there is the risk of the rotating blade of the morcellator cutting the extraction bag itself and parts of the infectious tissue passing back into the body cavity.

Therefore, the object of the invention can be considered that of specifying an access system for endoscopic operations, by way of which an extraction bag, in spite of the positive pressure in a body cavity, is expanded to such an extent that the tissue located in the extraction bag can be cut up without risk by means of a morcellator and removed.

This object is achieved by an access system for endoscopic operations according to independent claims 1, 9 and 15. Advantageous developments are the subject matter of the dependent claims.

SUMMARY

An access system for endoscopic operations consists of a trocar, a cover that is fittable on the trocar and at least one spreading element having a retaining portion and an effector portion, wherein the access system has, between the trocar and the cover in the fitted state, a receiving region for the retaining portion of the at least one spreading element. It is particularly advantageous with this configuration that the spreading element or, if present, several spreading elements is/are fittable individually on the trocar and yet are introducible without problems through the comparatively narrow access means.

In a further advantageous configuration, the trocar and the cover of the access system have a bayonet mount for fitting. In this way, the access system can be put together quickly and securely.

Furthermore, the receiving region of the access system can comprise an annular retaining ring.

Moreover, the retaining portion of the at least one spreading element can have a retaining clip adapted to the retaining ring.

Furthermore, the retaining ring can have at least one positioning portion adapted to the retaining clip of the at least one spreading element.

In a further configuration, the access system according to the invention can have 3 or 4 spreading elements. Depending on the specific embodiment, the access system according to the invention can also have 2 or 5 or 6 spreading elements, however.

In a further embodiment, the access system can comprise an extraction bag which is expanded by the effector portion of the at least one spreading element.

Moreover, the trocar can have a fluid feed. As a result, the extraction bag can be insufflated, i.e. blown up with nitrogen, carbon dioxide, helium or some other gas, independently of the body cavity, in order to build up a counterpressure to the insufflated body cavity. The expansion of the extraction bag is supported as a result. In this case, the insufflation gas can be fed via a distribution valve such that the insufflation pressure in the body cavity and in the extraction bag is maintained at the same or at least similar level.

A further embodiment of the access system according to the invention for endoscopic operations can consist of a trocar having a trocar sleeve, a cover that is fittable on the trocar and has a working duct and at least one spreading element, wherein the working duct extends concentrically within the trocar sleeve in the fitted state. The features of this embodiment can be used independently of the abovementioned embodiments or be combined with the abovementioned embodiment.

In a further embodiment, at least one portion of the at least one spreading element can extend within an intermediate space between the trocar sleeve and working duct. If the spreading elements have a flat or at least approximately flat cross section, this arrangement allows the precise orientation of the spreading elements around the trocar sleeve.

Furthermore, the at least one spreading element can have, at least in portions, a circular cylindrical contour which is adapted to the contour of the trocar sleeve and/or of the working duct. To this end, it is particularly advantageous for the portion in question of the spreading element to have a contour in the form of a circular cylindrical jacket, such that it bears as extensively as possible against the outer side of the working duct and against the inner side of the trocar sleeve.

The present embodiment of the access system according to the invention can also advantageously have 3 or 4, in particular cases also 2 or 5 or 6 spreading elements.

Likewise, the present configuration of the access system can comprise an extraction bag which is expanded by the effector portion of the at least one spreading element.

As described above, the access system according to the invention can have a fluid feed in the second embodiment, too.

Also proposed according to the invention is a method for assembling an access system for endoscopic operations, which comprises the following steps of

-   -   providing a trocar having a trocar sleeve,     -   providing a cover having a working duct,     -   providing at least one spreading element having a retaining         portion and an effector portion,     -   providing an extraction bag,     -   passing the effector portion of the at least one spreading         element through the trocar sleeve and into the extraction bag,     -   positioning the retaining portion of the at least one spreading         element in the trocar,     -   fitting the cover on the trocar such that its working duct         extends through the trocar sleeve and the retaining portion of         the at least one spreading element is clamped in place between         the trocar and cover, and     -   expanding the extraction bag by way of the at least one         spreading element.

As also already described above, it is particularly advantageous in this method for a suitable number of spreading elements to be introducible successively into the access system and into the extraction bag. The expanded working region in the extraction bag only arises when the spreading element or spreading elements are held securely in the trocar.

It goes without saying that the abovementioned features are usable not only in the combination specified in each case but also in other combinations or on their own without departing from the scope of the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is explained and described in more detail in the following text by way of a number of selected exemplary embodiments in conjunction with the accompanying drawings, in which

FIG. 1 shows a schematic perspective oblique view of the access system according to the invention in the assembled state,

FIG. 2 shows a schematic perspective oblique view of the trocar with spreading elements,

FIG. 3 shows a sectional illustration of the trocar,

FIG. 4 shows a sectional illustration of the cover,

FIG. 5 shows a side view of a spreading element,

FIG. 6 shows a side view of a spreading element.

DETAILED DESCRIPTION

The exemplary illustration in FIG. 1 shows a preferred exemplary embodiment of the access system 1 according to the invention for endoscopic operations in the assembled state. It consists of a trocar 2 having a trocar sleeve 14. It can additionally have a fluid feed 13, which is equipped for example with a Luer connector 20. The cover 3 of the access system 1 comprises a grip part 22 and a tubular working duct 15 which extends concentrically through the trocar sleeve 14 and is longer than the trocar sleeve 14 and therefore protrudes from the latter. Furthermore, the trocar system according to the invention includes a sealing cap 19 which allows the introduction of an instrument, for example a morcellator (not illustrated), but prevents gas from escaping from the body cavity or the extraction bag. In order to expand an extraction bag, use is made of four spreading elements 4, the effector portions 6 of which protrude between the trocar sleeve 14 and working duct 15. Their legs 23 are curved outwards in an approximately S-shaped manner such that the effector portions 6 of the spreading elements 4 lie on an imaginary circular cylindrical surface which lies concentrically around the trocar sleeve 14 and the working duct 15.

FIG. 2 shows the trocar 2 with three inserted spreading elements 4 and without the cover 3. The grooves of the bayonet mount 8 are illustrated on the trocar 2. Furthermore, FIG. 2 shows the retaining ring 9 of the receiving region 8 having four positioning portions 11 (three concealed). Located on the retaining ring 9 in the set-back positioning portions 11 are the retaining clips 10 of the three fitted spreading elements 4.

FIG. 3 shows the trocar 2 with its trocar sleeve 14, the retaining ring 9, the slots of the bayonet mount 8 and the fluid feed 13.

FIG. 4 shows the cover 3 with the grip part 22 and the working duct 15 with the sealing cap 19 in place thereon. The sealing cap 19 consists preferably of plastics material and can be a disposable product. Located in its interior are one or more valve flaps 24 which allow the introduction of an instrument but prevent gas from passing out in the opposite direction. The valve cap has protrusions which engage in corresponding recesses in the cover. Not illustrated are pins or protrusions which engage in the grooves of the bayonet mount 8 of the trocar 2.

FIGS. 5 and 6 show a spreading element 4 with its retaining portion 5, the retaining clip 10 and the effector portion 6. In FIG. 6, the contour 25, corresponding to a circular cylindrical jacket, of the retaining portion and of the effector portion is illustrated, said contour 25 being adapted to the intermediate space between the trocar sleeve 14 and working duct 15. 

1-15. (canceled)
 16. An access system for endoscopic operations, comprising: a trocar; a cover that is fittable on the trocar; and at least one spreading element having a retaining portion and an effector portion; wherein the access system has, between the trocar and the cover in a fitted state, a receiving region for the retaining portion of the at least one spreading element; wherein the receiving region comprises an annular retaining ring; and wherein the retaining portion of the at least one spreading element has a retaining clip adapted to the annular retaining ring.
 17. The access system according to claim 16, wherein the trocar and the cover have a bayonet mount for fitting.
 18. The access system according to claim 16, wherein the annular retaining ring has at least one positioning portion adapted to the retaining clip of the at least one spreading element.
 19. The access system according to claim 16, wherein the access system has 2 or 3 or 4 or 5 or 6 spreading elements.
 20. The access system according to claim 16, wherein the trocar has a fluid feed.
 21. An access system for endoscopic operations, consisting of: a trocar having a trocar sleeve; a cover that is fittable on the trocar and has a working duct and at least one spreading element; wherein the working duct extends concentrically within the trocar sleeve in a fitted state; wherein at least one portion of the at least one spreading element extends within an intermediate space between the trocar sleeve and working duct; and wherein the at least one spreading element has, at least in portions, a circular cylindrical contour which is adapted to a contour of the trocar sleeve and/or of the working duct.
 22. The access system according to claim 21, wherein the access system has 2 or 3 or 4 or 5 or 6 spreading elements.
 23. The access system according to claim 21, wherein the access system has a fluid feed.
 24. An access system for endoscopic operations, comprising: a trocar having a trocar sleeve; a cover that is fittable on the trocar and has a working duct and at least one spreading element; wherein the working duct extends concentrically within the trocar sleeve in a fitted state; wherein at least one portion of the at least one spreading element extends within an intermediate space between the trocar sleeve and working duct; and wherein the at least one spreading element has, at least in portions, a circular cylindrical contour which is adapted to a contour of the trocar sleeve and/or of the working duct.
 25. The access system according to claim 24, wherein the access system has 2 or 3 or 4 or 5 or 6 spreading elements.
 26. The access system according to claim 24, wherein the access system has a fluid feed. 